A special education legal resource discussing case law, news, practical advocacy advice, and developments in state and federal laws, statutes and regulations. Postings include insight and sometimes humor from Charles P. Fox, a Chicago, Illinois attorney who is also a parent of child with special needs, and other guest authors. Email: [email protected]

December 08, 2011

Most Schools Not Properly Implementing and Tracking Autism Interventions

Although the Individuals with Disabilities Education Act and No Child Left Behind both mandate that schools must provide research-based interventions for students, it appears that schools are often failing to provide such evidence-based methodologies. Results from an August 3, 2011 study from Michigan State University of more than 200 school professionals indicate that teachers are failing to use some of the most effective strategies for teaching children with autism. This is news? Parents already know that teachers may not be correctly applying the different treatment interventions to their children. And researchers have also known that there is a research-to-practice gap in autism interventions.

Participants in the Michigan study reported that of the four most common interventions they used which were research-based, 31% of teachers used that intervention for only part of the day. Additionally, many teachers (44%) reported they were not using the methodology at all on the students for whom they were reporting. The results of the Michigan study appear to parallel previous studies. Stahmer et al. hypothesized that service providers were using a variety of interventions, which varied greatly in quality and intensity and were not often based on research. To test their hypothesis, the researchers interviewed early intervention providers in focus groups to discover not only how they were implementing the different interventions in their programs, but also queried their understanding and training as they applied these programs into community settings. Of the 30 interventions listed by participants, only one-third were evidence-based for efficacy for children with autism. However, the providers believed that up to 50% of the interventions they used were research-based.

Participants also reported adapting the research-based interventions they were using, including combining multiple methodologies, in order to tailor them to their individual programs, needs of specific students, or their own teaching preferences, a controversial approach given that the efficacy of applying different interventions piecemeal has not been studied. Study participants also expressed concerns that both they and their paraprofessionals, on whom they relied extensively to provide the services, had not been adequately trained to implement these programs.

The National Research Council (2001) delineated key principles common to many intervention programs for young children with autism spectrum disorder but went on to state that “there are virtually no data on the relative merit of one model over another.” Although some states have developed best practice guidelines, other states list available treatments without considering the research. This lack of specificity can provide a conundrum for special education administrators as they attempt to decide which programs to implement. It’s a confusing world filled with multiple treatment options, new studies constantly coming down the pipeline to review, and multitudes of students who represent multiple disabilities, not just autism, requiring services. It’s hard to keep up.

Meanwhile, researchers assume that administrators are relying on efficacy data in their decision-making. In fact, administrators may instead be resorting to “practice wisdom,” which includes the opinion and observations of their staffs. Some administrators simply feel that the research studies are conducted in ideal laboratory settings (the so-called ivory towers of academia) and don’t relate to real-world students, teachers, and schools. The administrators often feel that the research data are unclear or inaccessible. Additionally, administrators are also weighing their organizational resources and ability to implement a specific methodology, whether the staff is adequately trained, the reactions of key stakeholders (e.g., parents and staff) to new methodologies, as well as the cost vs. benefit of different interventions.

Because of this disconnect between researchers and real-world practitioners, some researchers are suggesting a shift in the “efficacy to effectiveness” sequence; namely, introducing interventions into “real-world practice” early in their development. By focusing on the setting in which the intervention will be implemented, researchers can help ensure that methodologies will be incorporated into community settings because they will be more likely able to meet the needs of students, staff, and schools.

This is all well and good for future research protocols. But what about now? Parents should be asking what methodologies are being used for their children, what data is being collected because all effective interventions rely on good data collection, how they are being implemented, and ensure that the IEP reflects what those interventions are. Given that teachers are sometimes demonstrably unaware if an intervention is efficacy-based or not, parents also need to do some work on their own to determine if an intervention is research based. In 2009, the National Autism Center published the National Standards Project. This report, which systematically evaluated behavioral and treatment options for persons under 22 years of age with autistic spectrum disorders, provides a comprehensive evaluation of the various research-based interventions available (775 are analyzed) and recommendations for selecting treatment options to help families, caregivers, service providers, and educators make informed treatment decisions. This report will hopefully help both schools and parents in their decision-making processes and ensure that students ultimately receive research-based interventions applied correctly.